Handbuch der inneren Medizin: Bd.3/1 Diseases of the Esophagus

Measurements of Sphincter Strength.- 2.3.5. Variations of the Sphincteric Pressure.- 2.3.5.1. The Intrinsic Sphincteric Properties.- 2.3.5.2. Hormonal Control of the Sphincter Strength.- 2.3.5.3. The Response of the Lower Esophageal Sphincter to Increased Intragastric Pressure.- 2.3.5.4. Nervous Control of the Lower Esophageal Sphincter Pressure.- 3. Bolus Transport. Primary Peristalsis.- 3.1. Mechanical Activity.- 3.1.1. Oral Transport.- 3.1.2. Pharyngeal Transport.- 3.1.3. Electromyographic Studies of Deglutition.- 3.1.3.1. Leading Complex.- 3.1.3.2. Constrictor Musculature.- 3.1.3.3. Variations in Ancillary Activity.- 3.1.4. Esophageal Transport.- 3.1.4.1. The Peristaltic Progression.- 3.1.4.2. Longitudinal and Circular Musculature.- 3.1.4.3. Striated and Smooth Muscles.- 3.1.5. Transport through the Gastroesophageal Sphincter.- 3.2. Intraluminal Pressure Variations.- 3.2.1. The Deglutition Complex in the Pharynx and in the Pharyngoesophageal Sphincter.- 3.2.1.1. Relaxion of the High Pressure Zone.- 3.2.1.2. The e-(Elevation) Wave.- 3.2.1.3. The t-(Tongue) Wave.- 3.2.1.4. The p-(Peristaltic) Wave.- 3.2.2. The Deglutition Complex in the Esophagus.- 3.2.2.1. The Initial Negative Deflexion.- 3.2.2.2. The First Positive Wave.- 3.2.2.3. The Second Positive Wave.- 3.2.2.4. The Peristaltic Contraction.- 3.2.3. The Deglutition Complex in the Gastroesophageal Sphincter.- 3.3. Innervation.- 3.3.1. Innervation of Oropharyngeal Phase.- 3.3.1.1. The Deglutition Center in the Rhombencephalon.- 3.3.1.2. The Peripheral Afferent System.- 3.3.1.3. Elementary Reflexes Versus Swallowing.- 3.3.1.4. The Central Afferent System.- 3.3.1.5. The Cortical Control of the Deglutition Center.- 3.3.1.6. Interference with Other Centers.- 3.3.1.7. Efferent Pathways. Motoneurons.- 3.3.2. Innervation of the Esophageal Phase.- 3.3.2.1. Central Nervous Centers.- 3.3.2.2. Afferent Pathways.- 3.3.2.3. Efferent Pathways.- 3.3.2.4. The Intramural Nervous System.- 4. Reflex Responses of the Esophagus.- 4.1. Secondary Peristalsis.- 4.2. Esophageal Propulsive Force (E.P.F.).- 4.3. On-and off-Response; Duration Response.- 4.3.1. The "On" Response (Circular Muscle).- 4.3.2. The "Off" Response (Circular Muscle).- 4.3.3. The Duration Response (Longitudinal Muscle).- 4.4. Inhibition.- 4.4.1. Deglutitive Inhibition.- 4.4.2. Inhibition by Distension.- 4.5. Relaxion of the Gastroesophageal Sphincter.- 4.6. Other Reflexes.- 5. Retrograde Transport.- 5.1. Rumination-Eructation.- 5.2. Retching and Vomiting.- 5.3. Belching.- References.- 2 Diagnostic Procedures.- History and Symptoms of Esophageal Disease.- 1. Symptoms and Syndromes.- 1.1. Symptoms and their Significance.- 1.1.1. The Sensation of Obstruction.- 1.1.1.1. The Site of the Obstruction.- 1.1.1.2. The Site of the Receptors.- 1.1.1.3. The Sensation of "Choking".- 1.1.2. Regurgitation.- 1.1.2.1. The Volume of Regurgitate.- 1.1.2.2. The Taste.- 1.1.2.3. The Content.- 1.1.2.4. The Timing.- 1.1.2.5. The Association with Position.- 1.1.3. Pain.- 1.1.3.1. The Distribution.- 1.1.3.2. The Character.- 1.1.3.3. The Timing.- 1.2. Syndromes.- 1.2.1. "Spill-Over" and "Spill-Into" Disease.- 1.2.2. Obstruction Syndromes.- 1.2.2.1. The Stricture Syndrome.- 1.2.2.2. The Achalasia Syndrome.- 1.2.3. The So-Called "Functional" Dysphagias.- 2. History.- 2.1. Pharyngeal Problems.- 2.1.1. Pouch.- 2.1.2. Stricture or Web.- 2.1.3. Muscular and Neural.- 2.2. Esophageal Problems.- Radiological Examination of the Esophagus.- 1. The Radiological Technique.- 1.1. Equipment.- 1.1.1. The Standard Diagnostic X-Ray Unit.- 1.1.2. The Image Intensifier.- 1.1.3. Television Fluoroscopy.- 1.1.4. Spot Filming.- 1.2. The Recording Techniques Used with Image Intensifiers.- 1.2.1. Photofluorography.- 1.2.2. Cinefluorography.- 1.3. Techniques of Recording the Television Images.- 1.3.1. Cinefluorography.- 1.3.2. Video Recording.- 2. Contrast Materials.- 2.1. Positive Contrast Materials.- 2.1.1. Barium Sulfate.- 2.1.2. Iodinated Contrast Materials.- 2.1.3. Tantalum Powder.- 2.2. Negative Contrast Materials.- 3. The Radiological Examination.- 3.1. General Principles.- 3.2. Normal Radiological Anatomy and Physiology.- 3.2.1. Hypopharynx and Cervical Esophagus.- 3.2.1.1. Radiological Landmarks.- 3.2.1.2. Hypopharynx and Cervical Esophagus during Swallowing.- 3.2.1.3. Hypopharynx and Cervical Esophagus after Swallowing.- 3.2.1.4. The Modified Valsalva Maneuver.- 3.2.2. Thoracic Esophagus.- 3.2.2.1. Normal Motor Activity.- 3.2.2.2. Normal Esophagogram.- 3.2.3. Esophagogastric Region.- 3.3. Preparation of the Patient.- 3.4. Radiological Examination without Contrast Material.- 3.4.1. The Air Esophagogram.- 3.4.2. Mediastinal Widening.- 3.4.3. Mediastinal Calcifications.- 3.4.4. Signs Related to Esophageal Perforation or Rupture.- 3.4.5. Retention of Contrast Material.- 3.5. Radiological Examination with Contrast Material.- 3.5.1. Basic Technique of Examination.- 3.5.2. Abnormal Images.- 3.5.2.1. Filling Defects and Impressions.- 3.5.2.2. Narrowings.- 3.5.2.3. Changes in Mucosal Pattern.- 3.5.2.4. Crater-like Images.- 3.5.2.5. Diverticula, Perforations, Fistulas.- 3.6. Special Procedures.- 3.6.1. Examination of the Pharyngoesophageal Region.- 3.6.1.1. Examination without Contrast Material.- 3.6.1.2. Examination with Contrast Material.- 3.6.1.3. Abnormal Images of the Opacified Pharyngoesophageal Region.- 3.6.2. The Demonstration of Esophageal Varices.- 3.6.3. Pharmacoradiography.- 4. The Radiological Examination of the Esophagus in Children.- References.- Esophagoscopy.- 1. Introduction.- 2. Common Recommendations for All Endoscopic Examinations.- 3. Equipment and Techniques.- 3.1. Rigid Esophagoscopy.- 3.1.1. The Esophagoscope of Segal and Dubois de Montreynaud.- 3.1.2. The Eder-Hufford Esophagoscope.- 3.1.3. Results of Rigid Esophagoscopy.- 3.2. Flexible Esophagoscopy.- 3.2.1. Principle of the Fiberscopes.- 3.2.2. Instruments.- 3.2.3. Examination Technique.- 3.2.3.1. Preparation and Positioning of the Patient.- 3.2.3.2. Insertion of the Apparatus and Exploration.- 3.2.3.3. Associate Maneuvers.- 3.2.3.4. Advantages and Drawbacks.- 4. Indications and Contraindications.- 5. Accidents and Incidents.- 5.1. Accidents.- 5.1.1. Perforation.- 5.1.2. Hemorrhage.- 5.2. Incidents.- 5.2.1. Failure to Pass Pharyngoesophageal Sphincter.- 5.2.2. Respiratory Spasm.- 5.2.3. Pain.- 5.2.4. Bleeding.- References.- Exfoliative Cytology of the Esophagus.- 1. Introduction.- 2. Esophageal Cytological Techniques.- 2.1. Techniques Combined with Esophagoscopy.- 2.2. Abrasive Techniques.- 2.3. Lavage Techniques.- 2.4. Combined Techniques.- 3. An Appraisal of Cytologic Techniques.- 4. Normal Cytology of the Esophagus.- 5. Criteria for Malignancy in Esophageal Cytology.- 6. Cyto-Histological Correlations.- 7. Indications of Esophageal Cytology.- 8. Results of Esophageal Cytology.- 9. Diagnostic Errors.- 10. Cytology Compared with Other Diagnostic Techniques.- 11. Fluorescent Techniques in Esophageal Cytology.- 12. Cytology in Beningn Conditions of the Esophagus.- 13. Effects of Roentgen Therapy on Esophageal Cells.- 14. Cytology in the Early Diagnosis of Esophageal Cancer.- References.- The Manometric Examination of the Esophagus.- 1. The Balloon-Kymographic Method.- 2. Intraluminal Pressure Measurements.- 3. Interpretation of Intraluminal Pressure Measurements.- 4. The Perfused Catheter System.- 5. The Technique of Intraluminal Pressure Measurements.- References.- pH Measurements.- 1. pH Measurements in vitro.- 2. pH Measurements in vivo.- 3. The Pull-trough Technique.- 4. Fixed Location of pH Electrode.- 5. Interpretation of Results.- 6. The Acid Clearing Test.- 7. Protracted pH Measurements.- References.- PD Measurements.- 1. History.- 2. The Origin of the Potential Difference.- 3. Techniques of PD Measurements.- 4. PD Measurements in the Esophagus.- References.- The Acid Infusion Test.- 1. Procedure.- 2. Hazards of the Test.- 3. The Mechanism of Pain.- References.- Pharmacological Tests.- References.- Electromyography of the Esophagus.- 1. Introduction.- 2. Registration Method.- 3. The Electromyographic Tracings.- 3.1. The Pharyngoesophageal Sphincter.- 3.2. The Striated Muscle Segment of the Esophagus.- 3.3. The Transitional Zone between Striated and Smooth Muscles.- 3.4. The Smooth Muscle Segment of the Esophagus.- 3.5. The Gastroesophageal Sphincter.- 4. The Deglutitive Inhibition.- 5. Electromyography in Esophageal Diseases.- References.- 3 Motility Disturbances of the Esophagus.- Achalasia.- 1. Definition.- 2. Incidence.- 2.1. Age Distribution.- 2.2. Sex Distribution.- 2.3. Geographical Distribution and Incidence.- 3. Achalasia in Animals.- 4. Etiology and Pathogenesis.- 4.1. Genetic Factors.- 4.2. Neuromuscular Abnormalities.- 4.2.1. Anatomical Lesions.- 4.2.1.1. The Nuclei of the Brainstem.- 4.2.1.2. Vagal Nerve Fibres.- 4.2.1.3. The Intramural Nerve Plexus.- 4.2.1.4. Smooth Muscle.- 4.2.2. Pharmacological Defects.- 5. Clinical Features.- 5.1. Symptoms and Signs.- 5.2. Vigorous Achalasia.- 6. Technical Examinations.- 6.1. Radiology.- 6.1.1. Plain Chest Film.- 6.1.2. Radiological Examination with Contrast Medium.- 6.1.2.1. Minimal Achalasia.- 6.1.2.2. Mild Achalasia.- 6.1.2.3. Moderate Achalasia.- 6.1.2.4. Severe Achalasia.- 6.2. Manometry.- 6.2.1. Resting Pressures in the Gastroesophageal Sphincter.- 6.2.2. Resting Pressure in the Esophagus.- 6.2.3. The Deglutitive Response in the Gastroesophageal Sphincter.- 6.2.4. Deglutitive Responses in the Esophagus.- 6.3. Mecholyl Test.- 6.4. Cytological Examination.- 6.5. Endoscopic Examination.- 7. Differential Diagnosis.- 7.1. Other Causes of Megaesophagus.- 7.1.1. Chagas' Disease.- 7.1.1.1. Acute Phase.- 7.1.1.2. Chronic Chagas' Syndrome.- 7.1.1.3. Megacolon.- 7.1.1.4. Megaesophagus.- 7.1.2. Esophageal Cancer.- 7.1.3. Rare Causes of Esophageal Dilatation.- 7.2. Other Causes of Aperistalsis.- 7.3. Achalasia-like Disorders.- 7.4. Diffuse Spasm.- 7.5. Post-Vagotomy Dysphagia.- 7.6. Differential Diagnosis in Children.- 8. Complications and Associated Diseases.- 8.1. Carcinoma.- 8.1.1. Incidence.- 8.1.2. Age and Sex Distribution.- 8.1.3. Pathology.- 8.1.4. Pathogenesis.- 8.1.5. Signs and Symptoms.- 8.1.6. Treatment.- 8.2. Esophagitis.- 8.3. Bronchopulmonary Complications.- 8.4. Perforation.- 8.5. Associated Conditions.- 9. Natural History.- 10. Treatment.- 10.1. Medical and Psychiatric Therapy.- 10.2. Dilatations.- 10.2.1. Types of Dilators.- 10.2.1.1. Mechanical System.- 10.2.1.2. Hydrostatic System.- 10.2.1.3. Pneumatic System.- 10.2.2. Preventive Measures.- 10.2.3. Results.- 10.2.3.1. Immediate Results.- 10.2.3.2. Immediate Complications.- 10.2.3.3. Late Results.- 10.3. Surgical Treatment.- 10.3.1. Techniques.- 10.3.1.1. Operations Based on the Theory of "Idiopathic Dilatation".- 10.3.1.2. Operations Based on the Theory of Disturbance in Esophageal Innervation.- 10.3.1.3. Operations Aimed at Decreasing the Resistance at the Cardia.- 10.3.1.4. Operations to Replace Part of the Esophagus by Intestine.- 10.3.2. Results and Complications of Heller's Myotomy.- 10.3.2.1. Results.- 10.3.2.2. Complications.- 10.4. Sphincteric Pressures after Treatment.- 10.5. Myotomy or Forceful Dilatation?.- References.- Diffuse Esophageal Spasm.- 1. Definition.- 2. Incidence.- 3. Pathology.- 4. Symptoms.- 5. Technical Examinations.- 5.1. Radiology.- 5.2. Manometric Examinations.- 6. Related Conditions.- 6.1. Idiopathic Muscular Hypertrophy of Lower Esophagus.- 6.2. The Hypertensive Sphincter.- 7. Diagnosis.- 8. Treatment.- 8.1. Medical Treatment.- 8.2. Dilatation.- 8.3. Surgical Treatment.- References.- Post-Vagotomy Dysphagia.- 1. Definition.- 2. Incidence.- 3. Symptoms.- 4. Etiology and Pathogenesis.- 5. Treatment.- References.- Presbyesophagus.- 1. Pharynx.- 2. Esophagus.- 3. Gastroesophageal Sphincter.- 4. Nature of the Lesions.- References.- Esophageal Motility in Neonatal Infants.- 1. Introduction.- 2. Normal Motility.- 2.1. Mouth and Pharynx.- 2.2. Esophagus.- 2.2.1. The Esophagus at Rest.- 2.2.1.1. Pharyngoesophageal Sphincter.- 2.2.1.2. Esophageal Body.- 2.2.1.3. Gastroesophageal Sphincter.- 2.2.2. Deglutition.- 2.2.2.1. Pharyngoesophageal Sphincter.- 2.2.2.2. Esophageal Body.- 2.2.2.3. Gastroesophageal Sphincter.- References.- Motor Disorders Due to Collagen Diseases.- 1. Progressive Systemic Sclerosis.- 1.1. Definition and General Data.- 1.2. Esophageal Involvement in Progressive Systemic Sclerosis.- 1.2.1. Incidence.- 1.2.2. Pathology.- 1.2.3. Radiological Examination.- 1.2.4. Manometric Examination.- 1.2.5. Differential Diagnosis.- 1.2.6. Treatment.- 2. Systemic Lupus Erythematosus.- 3. Polymyositis-Dermatomyositis.- 4. Related Syndromes.- References.- Motor Disorders Due to Muscle Disorders.- 1. Myotonic Dystrophy (Steinert's Disease).- 1.1. Definition and General Data.- 1.2. Esophageal Involvement.- 2. Ocular Myopathy and Oculopharyngeal Myopathy.- 2.1. Definition and General Data.- 2.2. Pharyngoesophageal Involvement.- 3. Myasthenia Gravis.- 3.1. Definition and General Data.- 3.2. Pharyngoesophageal Involvement.- 4. Endocrine Disorders of Muscle.- References.- Motor Disorders Due to Lesions of the Central Nervous System.- 1. Brainstem Lesions.- 2. Poliomyelitis.- 3. Motor Neuron Disease.- 4. Extrapyramidal Disturbances.- 5. Stiff-man Syndrome.- 6. Dysautonomia.- References.- Motor Disorders Due to Peripheral Nerve Lesions.- 1. Motor Disorders Associated with Diabetes.- 2. Motor Disturbances Associated with Alcoholic Neuropathy.- References.- Emotional Disorders of the Esophagus.- 1. Globus Hystericus.- 1.1. Definition and Generalities.- 1.2. Clinical Findings.- 1.3. Diagnosis.- 1.4. Interpretation.- 1.5. Treatment.- 2. Esophageal Belching.- 2.1. Definition.- 2.2. Etiology.- 2.3. Clinical Findings.- 2.4. Pathophysiology.- 2.5. Treatment.- 3. Eructation or Belching.- 3.1. Definition.- 3.2. Mechanism of Eructation.- 3.3. Treatment.- 4. Merycism or Rumination.- 4.1. Merycism in Infants.- 4.1.1. Clinical Data.- 4.1.2. Interpretation.- 4.1.3. Treatment.- 4.2. Merycism in Adults.- 4.2.1. Clinical Data.- 4.2.2. Mechanism.- 4.2.3. Treatment.- References.- The Pathophysiological Basis of Gastroesophageal and Intestinoesophageal Reflux.- 1. The Gastroesophageal Closing Mechanism.- 2. Conditions Associated with Gastroesophageal or Intestinoesophageal Reflux.- 2.1. Sliding Hiatal Hernia.- 2.2. Gastroesophageal Incompetence in the Absence of Demonstrable Hiatal Hernia.- 2.3. Scleroderma with Esophageal Involvement and Related Conditions.- 2.4. Following Myotomy for Achalasia of the Esophagus.- 2.5. Vagotomy.- 2.6. Pregnancy.- 2.7. Gastric Operations.- 2.8. Prolonged Gastric Intubation.- References.- 4 Tumors of the Esophagus.- Benign Tumors and Cysts of the Esophagus.- 1. Classification.- 2. Incidence.- 3. Intramural Tumors and Cysts.- 3.1. Leiomyoma.- 3.1.1. Age and Sex Incidence.- 3.1.2. Pathology.- 3.1.3. Symptoms.- 3.1.4. Radiographic Signs.- 3.1.5. Esophagoscopy.- 3.1.6. Diagnosis.- 3.1.7. Complications.- 3.1.8. Treatment.- 3.2. Cysts.- 4. Intraluminal Tumors.- 4.1. Fibrovascular Polyp.- 4.2. Papillomas.- 4.3. Adenomas.- 5. Hemangiomas.- References.- Malignant Tumors of the Esophagus.- 1. Esophageal Carcinoma.- 1.1. Incidence and Etiology.- 1.2. Pathology.- 1.2.1. Squamous Cell Carcinoma.- 1.2.1.1. Site.- 1.2.1.2. Size.- 1.2.1.3. Macroscopic Appearance.- 1.2.1.4. Microscopic Appearance.- 1.2.1.5. Direct Spread.- 1.2.1.6. Lymphatic Metastases.- 1.2.1.7. Blood-Borne Metastases.- 1.2.2. Adenocarcinoma.- 1.2.3. Mixed Squamous and Adenocarcinoma.- 1.3. Clinical Features, Natural History, Symptoms and Signs.- 1.4. Investigations.- 1.4.1. Radiology.- 1.4.2. Endoscopy.- 1.4.3. Esophageal Cytology.- 1.4.4. Cervical Lymph Node Biopsy.- 1.4.5. Mediastinoscopy, Pneumomediastinography and Laparotomy.- 1.4.6. Other Investigations.- 1.5. Prognosis.- 1.5.1. Factors Influencing Prognosis.- 1.5.1.1. The Balance between the Aggressiveness of the Tumor and the Resistance of the Patient.- 1.5.1.2. Treatment.- 1.5.1.3. Sex.- 1.5.1.4. Site.- 1.5.1.5. Histology.- 1.5.1.6. Condition of the Patient.- 1.5.1.7. The Community in which the Patient Lives.- 1.6 Treatment.- 1.6.1. Comparison of Surgery and Radiotherapy.- 1.6.2. Anatomical Classification.- 1.6.3. Radiation Therapy.- 1.6.3.1. Squamous Carcinoma.- 1.6.3.2. The Level of the Esophageal Cancer.- 1.6.3.3. Adenocarcinoma.- 1.6.4. Surgical Treatment.- 1.6.4.1. Complications of Esophagogastrectomy.- 1.6.5. Preoperative and Postoperative Irradiation.- 1.6.6. Intubation.- 1.6.7. Cancer Chemotherapy.- 1.6.8. Treatment of Esophagotracheal Fistula.- 1.6.9. Results of Treatment.- 1.6.9.1. Results of Surgical Management.- 1.6.9.2. Results of Management of Squamous Esophageal Cancer by Irradiation.- 1.6.9.3. Results of Management of Squamous Esophageal Cancer by Irradiation and Surgery.- 2. Sarcoma.- 3. Pseudosarcoma and Carcinosarcoma.- 4. Malignant Melanoma.- 5. Metastatic Tumors.- 6. Other Rare Malignant Tumors of the Esophagus.- 6.1. Carcinoid Tumor.- 6.2. Paget's Disease.- 6.3. Hodgkin's Disease.- 6.4. Granular Cell Myoblastoma.- 6.5. Verrucous Squamous Cell Carcinoma.- Acknowledgements.- References.- 5 Inflammatory Lesions of the Esophagus.- Reflux Esophagitis.- 1. Introduction.- 2. General Considerations.- 2.1. Hiatal Hernia.- 2.2. Esophagitis.- 2.3. Reflux.- 2.4. Heartburn.- 2.5. Pathogenesis.- 3. Clinical Features.- 4. Roentgen Features.- 5. Endoscopy.- 6. Manometry.- 7. Diagnosis and Differential Diagnosis.- 8. Therapy.- 9. Other Types of Reflux Esophagitis.- References.- Lower Esophagus Lined with Columnar Epithelium.- 1. Historical Aspects, Definition, Incidence and Distribution.- 2. Pathologic Anatomy.- 3. Pathophysiology.- 4. Symptomatology.- 5. Diagnosis.- 6. Differential Diagnosis.- 7. Treatment.- References.- Caustic Lesions of the Esophagus.- 1. Incidence.- 2. Etiology.- 3. Pathogenesis.- 4. Pathology.- 4.1. The Acute Necrotic Phase.- 4.2. The Ulceration and Granulation Phase.- 4.3. The Phase of Cicatrization and Stricture Formation.- 5. Clinical Features.- 6. Diagnosis.- 7. Treatment.- References.- Acute Infectious Disease.- 1. Suppurative Esophagitis.- 2. Esophagitis Secondary to Infectious Disease.- References.- Tuberculosis of the Esophagus.- 1. Incidence.- 2. Pathogenesis.- 3. Pathology.- 4. Clinical Features.- 5. Diagnosis.- 6. Complications.- 7. Prognosis.- 8. Treatment.- References.- Syphilis of the Esophagus.- 1. Incidence.- 2. Pathology.- 3. Clinical Features.- 4. Technical Examination.- 5. Diagnosis.- 6. Complications.- 7. Treatment.- References.- Esophageal Mycoses.- 1. Monilial Esophagitis.- 1.1. History.- 1.2. Incidence.- 1.3. Etiology.- 1.4. Pathogenesis.- 1.5. Clinical Features.- 1.6. Technical Examination.- 1.7. Diagnosis and Differential Diagnosis.- 1.8. Complications.- 1.9. Prognosis.- 1.10. Treatment.- 2. Other Mycotic Infections of the Esophagus.- 2.1. Actinomycosis.- 2.2. Mucormycosis.- 2.3. Histoplasmosis.- 2.4. Blastomycosis.- References.- Granulomatous Esophagitis.- 1. Crohn's Disease of the Esophagus.- 2. Sarcoidosis of the Esophagus.- References.- 6.- Esophageal Webs and Rings.- 1. Introduction.- 2. Upper Esophageal Web.- 2.1. Definition.- 2.2. Incidence.- 2.3. Etiology and Pathogenesis.- 2.4. Pathology.- 2.5. Clinical Features.- 2.6. Technical Features.- 2.7. Diagnosis.- 2.8. Differential Diagnosis.- 2.9. Complications and Prognosis.- 2.10. Treatment.- 3. Middle Esophageal Web.- 3.1. Incidence.- 3.2. Etiology.- 3.3. Clinical Features.- 3.4. Technical Features.- 3.5. Diagnosis.- 3.6. Prognosis and Treatment.- 4. Lower Esophageal Web.- 4.1. Incidence and Etiology.- 4.2. Clinical and Technical Features.- 4.3. Diagnosis.- 4.4. Comment.- 5. Squamocolumnar Ring.- 5.1. Definition.- 5.2. Incidence.- 5.3. Etiology and Pathogenesis.- 5.4. Pathology.- 5.5. Clinical Features.- 5.6. Technical Features.- 5.7. Diagnosis.- 5.8. Differential Diagnosis.- 5.9. Complications and Prognosis.- 5.10. Treatment.- 5.11. Comment.- References.- 7.- Esophageal Diverticula.- 1. Lateral Pharyngeal Diverticula and Pouches.- 2. The Hypopharyngeal Diverticulum (Zenker's Diverticulum).- 2.1. Incidence.- 2.2. Pathophysiology and Pathogenesis.- 2.3. Pathology.- 2.4. Symptoms.- 2.5. Diagnosis.- 2.6. Complications of Untreated Diverticula.- 2.7. Evolution and Prognosis.- 2.8. Treatment.- 3. Esophageal Diverticula.- 3.1. Midesophageal Diverticula.- 3.1.1. Pathogenesis and Pathology.- 3.1.2. Symptoms.- 3.1.3. Complications.- 3.1.4. Diagnosis.- 3.1.5. Treatment.- 3.2. Epiphrenic Diverticula.- 3.2.1. Incidence.- 3.2.2. Pathology.- 3.2.3. Etiology.- 3.2.4. Symptoms.- 3.2.5. Diagnosis.- 3.2.6. Complications.- 3.2.7. Treatment.- 3.3. Subphrenic Diverticula.- References.- 8 Congenital Anomalies of the Esophagus.- Esophageal Atresia.- 1. History.- 2. Incidence.- 3. Embryology.- 4. Pathological Anatomy.- 5. Pathophysiology.- 5.1. Hydramnios.- 5.2. Prematurity.- 5.3. Pneumonia.- 6. Associated Anomalies.- 7. Diagnostic Procedures.- 7.1. Nasogastric Intubation.- 7.2. Radiological Examinations.- 8. Treatment.- 8.1. Principles of Management.- 8.2. Preoperative Management.- 8.3. Operative Management.- 9. Anastomotic Complications.- 9.1. Leaks.- 9.2. Strictures.- 9.3. Recurrent Trachoesophageal Fistula.- 9.4. Neurogenic Dysfunction.- 10. Trends in Survival.- References.- Isolated Trachoesophageal Fistula.- References.- Bronchoesophageal Fistula.- References.- Cleft Larynx. Laryngotracheoesophageal Cleft. Persistent Esophagotrachea.- References.- Vascular Rings.- Vascular Anomalies Causing Tracheoesophageal Symptoms.- 1. Introduction.- 2. Clinical Picture.- 2.1. Respiratory Symptoms.- 2.2. Feeding Problems.- 3. Different Types of Anomalies.- 3.1. Aberrant Right Subclavian Artery (A. lusoria).- 3.2. Double Aortic Arch.- 3.3. Right-sided Aortic Arch.- 3.4. Left-sided Aortic Arch with Right-sided Descending Aorta.- 3.5. Cervical Aortic Arch.- 3.6. Aberrant Left Pulmonary Artery.- References.- 9 Mechanical Lesions of the Esophagus.- Traumatic Lesions of the Esophagus.- 1. Pathogenesis.- 1.1. Blunt Trauma.- 1.2. Penetrating Wounds.- 1.3. Mechanical Agents Acting from Inside the Lumen.- 2. Symptoms.- 3. Diagnosis.- 4. Treatment.- References.- Foreign Bodies in the Esophagus.- 1. Incidence.- 2. Pathogenesis and Pathology.- 3. Clinical Features.- 4. Diagnosis.- 5. Treatment.- 6. Complications.- 7. Esophageal Obstruction from Meat Impaction.- References.- Spontaneous Rupture of the Esophagus.- 1. Definition.- 2. History and Incidence.- 3. Pathogenesis.- 4. Pathology.- 5. Clinical Features.- 6. Technical Examinations.- 7. Diagnosis.- 8. Prognosis.- 9. Treatment.- 10. Esophageal Rupture in Children.- References.- Iatrogenic Perforations of the Esophagus.- 1. Definition.- 2. Incidence.- 3. Etiology and Pathogenesis.- 4. Symptoms and Diagnosis.- 5. Treatment.- References.- Mallory-Weiss Syndrome.- 1. Definition.- 2. History.- 3. Incidence.- 4. Pathogenesis.- 5. Clinical Features.- 6. Diagnosis.- 7. Pathology.- 8. Treatment.- References.- Intramural Rupture and Bleeding.- 1. Etiology.- 2. Pathogenesis.- 3. Symptoms.- 4. Radiological Features and Diagnosis.- 5. Treatment.- References.- 10.- Esophageal Varices.- 1. Definition.- 2. Anatomy and Histopathology.- 3. Incidence.- 4. Etiology and Pathogenesis.- 4.1. Esophageal Varices Secondary to "Portal Hypertension".- 4.1.1. Presinusoidal Causes.- 4.1.1.1. Prehepatic Pathology.- 4.1.1.2. Presinusoidal Intrahepatic Disorders.- 4.1.2. Sinusoidal Causes.- 4.1.2.1. Acute Hepatitis.- 4.1.2.2. Fatty Liver.- 4.1.2.3. Early Stage of Chronic, Non-Suppurative, Destructive Cholangitis (Primary Biliary Cirrhosis).- 4.1.2.4. Kupffer Cell Hypertrophy with Perisinusoidal Fibrosis.- 4.1.3. Postsinusoidal Portal Hypertension.- 4.1.3.1. Postsinusoidal Intrahepatic Causes.- 4.1.3.2. Extrahepatic Postsinusoidal Portal Hypertension.- 4.2. Esophageal Varices without Portal Hypertension.- 4.2.1. Obstruction of Vena Cava Superior (Downhill Varices).- 4.2.2. Carcinoma at the Gastroesophageal Junction.- 4.2.3. Idiopathic Esophageal Varices.- 4.2.4. Esophageal Varices in Patients with Liver Disease, but Normal Portal Pressure.- 4.3. Unclassified Miscellaneous Causes.- 5. Clinical Features: Bleeding.- 5.1. Incidence.- 5.2. Pathogenesis of the Bleeding.- 5.3. Clinical Symptoms.- 6. Diagnosis.- 6.1. Diagnosis of Esophageal Varices.- 6.1.1. Barium Swallow.- 6.1.2. Esophagoscopy.- 6.1.3. Splenoportography.- 6.1.4. Umbilical Vein Portography.- 6.1.5. Ammonia Tolerance; Indirect Test for Esophageal Varices.- 6.1.6. Evaluation of the Different Techniques Used.- 6.2. Diagnosis of Bleeding from Esophageal Varices.- 7. Therapy.- 7.1. Medical Management of Bleeding Varices.- 7.1.1. Blood Transfusion.- 7.1.2. Prevention of Hepatic Encephalopathy (in Cirrhotics).- 7.1.3. Arrest of Further Bleeding.- 7.1.3.1. Drugs.- 7.1.3.2. Gastric Cooling.- 7.1.3.3. Balloon Tamponade.- 7.1.3.4. Intraarterial Infusion.- 7.2. Surgical Management of Bleeding Esophageal Varices.- 7.2.1. Emergency Surgical Treatment.- 7.2.2. Elective Surgical Treatment in Liver Cirrhosis with Bleeding Varices.- 7.2.3. Prophylactic Shunt Operations in Liver Cirrhosis.- 7.2.4. Prophylactic Operations in Extrahepatic Block.- 7.3. Thoracic Duct Drainage.- 7.4. Transumbilical Portal Decompression.- 7.5. Sclerosing Injections for Esophageal Varices.- References.- 11.- Hiatus Hernia.- 1. Definition and Classification.- 2. Incidence.- 3. Anatomical Basis, Etiology and Pathogenesis.- 4. Pathological Anatomy.- 5. Clinical Features.- 5.1. Symptoms.- 5.2. Hiatus Hernia in Infants.- 5.3. Hiatus Hernia during Pregnancy.- 5.4. Postoperative Hernias.- 5.5. Traumatic Hiatus Hernias.- 5.6. Signs.- 6. Technical Features.- 6.1. Radiological Examination.- 6.1.1. Technique of X-ray Examination.- 6.1.2. Radiological Demonstration of Reflux.- 6.1.3. Interpretation of X-ray Findings.- 6.1.4. Paraesophageal Hernia.- 6.1.5. Mixed Hernias.- 6.1.6. Invagination.- 6.1.7. Note on Terminology.- 6.2. Endoscopy.- 6.2.1. Esophagoscopy.- 6.2.2. Gastroscopy.- 6.2.3. Peritoneoscopy.- 6.3. Manometry.- 6.4. pH Measurements.